Forms
Adult Human Resources

Division of Adult and Career Education Forms

Form #	Form Title	Form Description	Type
	Request for Consideration of Prior Service from Another Site	Part time and other non-tenured Certificated employees request for consideration of prior service from another site
1038	Certificated Request for Return from Leave	For permissive, illness, rest, industrial injury, or pregnancy disability leaves
1065	Certificated Request for Leave of Absence	To be completed by Certificated employees requesting a leave of absence
1086	Teacher Employment or License Denial Cases	To be completed by applicants who have been denied a previously requested teaching license or have been denied employment due to an adverse action
1088	Report of Evaluation of Less Than Satisfactory Service	To be completed by applicants who have received a less than satisfactory service evaluation
6087	Report of Conviction / Pending Criminal Court Cases	To be completed by applicants who have pending criminal court cases or have been convicted, fined, placed on probation, or given a suspended sentence regardless or dismissal or expungement
8101	Employment Verification Request Form
8152	Certificated Resignation Form	All certificated employees who intend to resign from certificated service with the Los Angeles Unified School District must complete this form
8457	Tuberculosis Clearance & Certification of Medical Clearance	Verification of TB and health clearance. To be completed by a physician after selected for employment as a teacher or substitute This download is a set and includes forms 8457 and 8459.
8459	Tuberculosis Clearance & Certification of Medical Clearance	Verification of TB and health clearance. To be completed by a physician after selected for employment as a teacher or substitute. This download is a set and includes forms 8457 and 8459.
ASA	Application for Step Advancement	Application for Step Advancement
CA	Application for Conference, Workshop or Seminar Attendance	Application for Conference, Workshop or Seminar Attendance
CP	Application for Conference/Workshop Presentation	Application for Conference/Workshop Presentation
CW	Application for College Course Work Approval	Application for College Course Work Approval
D	Application for Teacher Demonstration	Application for Teacher Demonstration
O	Application for Observation	Application for Observation

Office of Risk Management Forms

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